Health Care Management and Rehabilitation Skills Training for Treating Serious Mental Illness in Older People

This study has been completed.
Sponsor:
Collaborator:
Information provided by:
Dartmouth-Hitchcock Medical Center
ClinicalTrials.gov Identifier:
NCT00169052
First received: September 11, 2005
Last updated: September 6, 2013
Last verified: September 2001
  Purpose

This study will evaluate the effectiveness of a health management and supported rehabilitation intervention in treating serious mental illnesses in older people.


Condition Intervention
Schizophrenia
Schizoaffective Disorder
Bipolar Disorder
Major Depression
Behavioral: Health Care Management and Supported Rehabilitation

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Single Blind
Primary Purpose: Treatment
Official Title: Rehabilitation and Health Care for Elderly With SMI

Resource links provided by NLM:


Further study details as provided by Dartmouth-Hitchcock Medical Center:

Primary Outcome Measures:
  • independent living, social and health behavior skills
  • preventive health care

Secondary Outcome Measures:
  • Acute emergency, hospitalization and long-term institution-based care

Estimated Enrollment: 180
Study Start Date: September 2001
Estimated Study Completion Date: August 2006
Detailed Description:

This randomized, controlled study will evaluate the effectiveness of a health management (HM) and supported rehabilitation (SR) intervention for 180 older persons (age 50+) with serious mental illness. We will address the following specific aims and hypotheses:

Specific Aim 1- To compare the effectiveness of SR/HM to UC in improving independent living skills and health management. We hypothesize that compared to older individuals with SMI receiving UC, individuals receiving SR/HM will have better independent living skills and health management, evidenced by:

  1. Better community living skills and better social skills based on performance-based measures and self-reports of functioning, and
  2. Better medication management skills based on performance-based and self-report measures and greater use of preventive and routine primary health care (including annual check-ups with a primary care provider and participation in preventive health care).

Specific Aim 2- To compare the effectiveness of SR/HM to UC in decreasing the use of high-cost acute and long-term institution-based services. We hypothesize that compared to older individuals with SMI receiving UC, individuals receiving SR/HM will use fewer high cost services, including emergency room visits, acute hospitalizations, and nursing home care. In addition, the reduced use of high cost institution-based services will be associated with better independent living skills and health management practices resulting from the SR/HM intervention.

We will also evaluate the following secondary, exploratory hypotheses:

  1. The SR/HM intervention will be associated with better general health status.
  2. The effectiveness of SR/HM in improving living skills and community functioning will be greatest for individuals with low levels of cognitive impairment.

In addition, we will describe outpatient service utilization for SR/HM and UC models within each study site in order to present a more comprehensive account of services used by study participants.

Little is known about how to provide effective rehabilitation and health management services to older persons with serious mental illness (SMI) to decrease the use of high-cost institution-based services. To address this need, we developed a supported rehabilitation and health management (SR/HM) intervention for older persons with SMI that addresses functioning in two areas essential for preventing hospitalizations and long-term institutional care: (1) enhanced independent living skills and (2) improved health management. The supported rehabilitation (SR) component consists of skills training aimed at improving competence in everyday functioning, including community living skills and social skills. The health management (HM) component consists of training in health management skills and health case management by nurses who monitor and facilitate routine preventive and acute health care. Results from a pilot study indicate that SR/HM is effective in improving independent living skills and health management for older persons with SMI.

The aims of this study are to test the effectiveness of the SR/HM intervention in improving the functioning and health care of older persons with SMI and in reducing the use of high cost, acute and long-term institution-based care. The proposed research will compare the SR/HM intervention to usual care (UC) in a randomized, controlled study of 180 individuals age 60 and older with SMI living in the community.

  Eligibility

Ages Eligible for Study:   50 Years and older
Genders Eligible for Study:   Female
Criteria

Inclusion Criteria:

  • age 50+ with schizophrenia,schizoaffective disorder,bipolar disorder, major depression with functional impairment

Exclusion Criteria:

  • dementia, life threatening acute medical condition.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00169052

Locations
United States, Massachusetts
Freedom Trail Clinic
Boston, Massachusetts, United States, 02114
Massachusetts Mental Health Center
Boston, Massachusetts, United States, 02115
United States, New Hampshire
Community Council of Nashua
Nashua, New Hampshire, United States, 03060
Sponsors and Collaborators
Dartmouth-Hitchcock Medical Center
Investigators
Principal Investigator: Stephen J Bartels, MD Dartmouth
  More Information

No publications provided

ClinicalTrials.gov Identifier: NCT00169052     History of Changes
Other Study ID Numbers: R01 MH62324, R01MH062324, DSIR 82-SEMS
Study First Received: September 11, 2005
Last Updated: September 6, 2013
Health Authority: United States: Federal Government

Keywords provided by Dartmouth-Hitchcock Medical Center:
geriatric,
older
serious mental illness
SMI

Additional relevant MeSH terms:
Mental Disorders
Bipolar Disorder
Depression
Depressive Disorder
Psychotic Disorders
Schizophrenia
Depressive Disorder, Major
Affective Disorders, Psychotic
Mood Disorders
Behavioral Symptoms
Schizophrenia and Disorders with Psychotic Features

ClinicalTrials.gov processed this record on September 15, 2014